[Prevention of peritonitis during continuous ambulatory peritoneal dialysis. Value of disconnectable systems]

Peritonitis remains the major obstacle to the acceptance of continuous ambulatory peritoneal dialysis as a long-term dialysis technique. In January, 1985, Y connectors were introduced into our continuous ambulatory peritoneal dialysis programme, and a two-year prospective randomized trial for all new patients was initiated in which the Y connection system was compared with the conventional technique in the prevention of peritonitis (group I). At the same time, 16 patients (group II), with a high incidence of peritonitis episodes were switched from the conventional technique to the Y connection system, while 55 patients (group III), remained on the conventional technique. Group IA patients (27 new patients using the Y connection system), developed peritonitis every 23 patient-months. Group IB patients (28 new patients using the conventional technique), developed peritonitis every 12.2 patient-months. The difference between these two sub-groups was statistically significant (P less than 0.02). Before their transfer to the Y connection system, group II patients developed peritonitis every 10 patient-months and thereafter one every 24 patient-months (P less than 0.001). Group III patients were divided into 12 continuous cyclic peritoneal dialysis patients with peritonitis every 24 patients-months, and 43 continuous ambulatory peritoneal dialysis patients with peritonitis every 11.7 patient-months. The Y connector therefore proved to be a simple and safe procedure effective in reducing the peritonitis rate in patients on continuous ambulatory peritoneal dialysis.